Claims Forms
Injured workers need to complete a variety of forms throughout the claims process. Access the most up to date forms here.
LWCC is a private, nonprofit mutual insurance company and the largest workers’ compensation carrier in Louisiana. Our purpose is to help Louisiana thrive.
Contact LWCC
There are many ways to get in touch with our team.
225-924-7788
800-519-7787 (toll free)
Representatives are available to assist you Monday-Friday, 8AM-5PM. Please call and follow the prompts to get your message to the right department.
Policy billing
Press 1
Making a payment on your policy, or if you have a question regarding the balance on your invoice
Claims
Press 2
Reporting a new claim
Then Press 1
If you are an injured worker
Then Press 2
If you are policyholder or agent
Then Press 3
If you are a medical provider
Then Press 4
Form 1010 or Utilization Review
Then Press 1
Medical Bill Status
Then Press 2
Electronic or previously mailed payment
Then Press 3
Premium audit
Press 3
Scheduling or rescheduling an audit, checking audit status, or for general audit questions
Agents
Press 4
For agent partners experiencing online issues or with questions related to your agency
Policyholder services
Press 5
Inquiring about policy status, classifications, rating, loss runs, or if you have general policy questions
Company directory
Press 6
Reaching a specific employee at LWCC by name by locating them in the company directory
All other calls
Press 0
Making a payment on your policy, or if you have a question regarding the balance on your invoice
For reporting a new claim or to determine which claim rep is assigned to a file
For inquiries and questions regarding your premium audit
For policy status, coverages, loss runs, and all other inquiries
For inquiries or questions for LWCC’s Safety Services department
For submitting signed Non-Election Notice, Personal Guaranty, or other required documents when binding an LWCC policy
For submitting completed Agent of Record letter forms
Regular Bill Payments
LWCC
P.O. Box 919142
Dallas, TX 75391-9142
For mailing standard payments to LWCC. Please include the payment coupon from the bottom of your invoice. Make checks payable to LWCC and write your policy number on the check.
Overnight Bill Payments
JP Morgan Chase
Attn: LWCC — LB #919142
14800 Frye Road, 2nd floor
Ft. Worth, TX 76155
For mailing payments to LWCC for overnight processing. Please include the payment coupon from the bottom of your invoice. Make checks payable to LWCC and write your policy number on the check.
Medical Billing
LWCC
Attn: Medical Bill Review
PO Box 2939
Clinton, IA 52733
For mailing all HCFA, UB and dental bills for bill review. Please include medical records related to the dates of service on the bills, including reconsiderations.
General Claims Mail
LWCC
PO Box 98052
Baton Rouge, LA 70808
For mailing all injured worker forms, reports, reimbursements, and bills.
Manage your policy online
Policyholders and agents can log in to gain full access to current information regarding LWCC policies and workers’ comp claims.
Report a Claim
Getting accidents reported immediately is very important. LWCC offers you several quick, easy ways to report claims. We will take care of the filing requirements and deadlines with state or federal agencies on your behalf.
The fastest way to report a claim.
Log in to your account, select “report claim,” and fill in the details about the accident being reported. Our expert claims team will do the rest.
Don’t have a login?
All policyholders are invited to create an account login. In addition to reporting claims quickly and easily online, you’ll also gain access to policy actions, information, and documents.
Click register for an accountSTEP 1
Access and fill out the First Report of Injury or Illness Form
Complete this form, distributed by Louisiana Workforce Commission’s Office of Workers’ Compensation, to begin the claim reporting process.
Click here access the formSTEP 2
Email the form to onlineclaims@lwcc.com
If you’re sending attachments with the form, please include the injured employee’s name and your policy number for identification purposes.
If necessary, an LWCC claims service professional will call you within 24 hours to discuss the injury.
STEP 1
Access and fill out the First Report of Injury or Illness Form
Complete this form, distributed by Louisiana Workforce Commission’s Office of Workers’ Compensation, to begin the claim reporting process.
Click here access the formSTEP 2
Fax the form to 225-231-2301
If you’re sending attachments with the form, please include the injured employee’s name and your policy number for identification purposes.
If necessary, an LWCC claims service professional will call you within 24 hours to discuss the injury.
Call 225-924-7788
800-519-7787 (toll free)
then press 2, then press 1
Our toll-free, 24-hour Claims Reporting Hotline puts you in touch with a friendly claims service professional who will obtain your information, handle the administrative paperwork, and process the claim for you.
Make a payment
9/18/24 Notice: Payee ACH code for payments to LWCC – 0000408976
In September 2024, LWCC transitioned to a new payment system. If you utilize ACH debit block fraud protection, please provide your bank with Payee Code: 0000408976 prior to making a payment.
No action is needed if you do not utilize ACH debit block fraud protection or if paying with a debit or credit card.
Pay and manage your bills online
Sign in using your LWCC login to view account balances, make secure online payments, set up or modify automatic payments, and view payment history.
Make a one-time payment
Why should I register for online payment?
Registering streamlines the payment process by eliminating the need to enter your policy number and pay code each time. Registered users can save multiple payment methods in their wallet, set up automatic payments, and view their payment history.
Payment methods for registered users:
eCheck (checking or savings), debit card, or credit card
Quote Payments
For new policyholders who recently bound a quote with LWCC, please enter your quote number and your company’s mailing ZIP code to make your first payment and issue your policy.
An error has occurred. Please contact LWCC Billing Department at 225-924-7788 or 1-800-519-7787, prompt 1.
Oops! Something went wrong while submitting the form.
Policy Payments
For policyholders ready to make a payment on an invoice, please enter your policy number and the pay code found on your latest invoice.
An error has occurred. Please contact LWCC Billing Department at 225-924-7788 or 1-800-519-7787, prompt 1.
Oops! Something went wrong while submitting the form.
Did you know LWCC could process your payments automatically?
Paying as a registered user can streamline your payment process by eliminating the need to enter your policy number and pay code each time. Registered users can also save multiple payment methods in their wallet, set up automatic payments, and view their payment history.
Call 225-924-7788
800-519-7787 (toll free)
then select option 1
Billing representatives are available Monday through Friday, 8am to 5pm, to assist with payments and answer any policy billing questions.
What should I have ready to make my payment over the phone?
Have your policy number and preferred payment method available.
When mailing your policy payment, please include the payment coupon from the bottom of your invoice. Make checks payable to LWCC and write your policy number on the check.
Mail regular bill payments to:
LWCC
P.O. Box 919142
Dallas, TX 75391-9142
Mail overnight bill payments to:
JP Morgan Chase
Attn: LWCC – LB# 919142
14800 Frye Road, 2nd floor
Ft. Worth, TX 76155